Editorial: Paying too much for too little health care

Exotic prescription drugs and extraordinary end-of-life efforts are not the only factors driving up the cost of health care. It turns out that routine procedures such as colonoscopies cost far more in the United States than in other countries, and vary widely in price. In Tampa, for example, patients pay from $980 to $3,496 in out-of-pocket and insurance costs for a colonoscopy. There is no legitimate reason for such wide differences, and bringing health care costs under control will require increased efforts by consumers and government to demand more openness about pricing and to comparative shop.

More than 10 million people get colonoscopies each year, at a cost of more than $10 billion. In a case study, the New York Times found that even after insurer negotiations, colonoscopy bills cost thousands of dollars and vary in price from city to city and provider to provider. In many European countries, the screening costs just a few hundred dollars and provides care no different than in the United States.

In a functioning free market, increasing numbers of colonoscopies should have brought decreasing costs from economies of scale and as consumers shopped around. Instead, the health care industry found more ways to profit. Among the factors contributing to the high cost cited by the New York Times: high fees at outpatient surgery centers owned by doctors performing the procedures; increased use of anesthesiologists even though colonoscopies do not require general anesthesia; and more frequent colonoscopies than guidelines recommend.

Colonoscopies account for a 53 percent decline in deaths in patients who had precancerous polyps removed — a testament to the need for preventive care. But the data doesn't demonstrate that colonoscopies are the best way to detect anomalies, and there are cheaper effective screening methods regularly used by other countries. Yet businesses that help doctors set up special clinics advertise huge returns on investment and millions in revenue to owners. Those high prices strain family budgets by contributing to higher insurance deductibles, premiums and co-payments. And aggressive marketing means more Americans get colonoscopies than are necessary. Some experts say a quarter of Medicare patients are screened more often than recommended.

Patients in the United States are paying too much for too little, and there isn't an easy fix to ensure the priority is on the patient rather than the paycheck. Colonoscopies are just one element in the nation's $2.7 trillion annual health care bill, and they are important preventive care. But their overuse and inexplicable pricing reflect a larger problem: a labyrinthine payment system for hospitals and physicians, focused on steep prices for basic services, anchored in place by entrenched interests lobbying for the status quo. Part of the solution will be more openness about pricing as the Affordable Care Act takes hold — and more assertive consumers willing to ask more questions as they shop for the best treatment at the right price.